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Infective Endocarditis: Update on Epidemiology, Outcomes, and Management

  • Valvular Heart Disease (TL Kiefer, Section Editor)
  • Published:
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Abstract

Purpose of Review

Infective endocarditis remains a highly mortal disease, yet the diagnosis often is missed or made only late in the disease course. The spectrum of patients presenting with endocarditis is shifting with different risk factors, predisposing patient characteristics, and treatment recommendations than in the past. This review addresses changes in the epidemiology of infective endocarditis, along with current diagnostic imaging modalities, treatment recommendations, and mortality trends.

Recent Findings

Risk factors for endocarditis now include the growing population of adults with congenital heart disease and patients with frequent healthcare contact for other comorbidities, as well as patients who are hemodialysed and immunocompromised or use intravenous drugs. Although transthoracic and transesophageal echocardiography are essential for diagnosis, additional testing (nuclear, computed tomographic, and magnetic resonance imaging) is helpful in selected patients. Early surgical management, even in high-risk patients, has a mortality benefit because eradication of infection with antibiotics alone is difficult and because valve destruction often results in hemodynamic compromise.

Summary

As part of a broad differential diagnosis, clinicians should consider the diagnosis of endocarditis in patients with risk factors, even when the clinical presentation is nonspecific. Blood cultures and echocardiography are the first steps for diagnosis. Other imaging modalities can enhance diagnosis, particularly in patients with intracardiac devices or prosthetic material. Evidence from observational studies support early surgical intervention to reduce morbidity and mortality from this lethal condition.

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Correspondence to Catherine M. Otto.

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Logan L. Vincent and Catherine M. Otto declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Valvular Heart Disease

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Vincent, L.L., Otto, C.M. Infective Endocarditis: Update on Epidemiology, Outcomes, and Management. Curr Cardiol Rep 20, 86 (2018). https://doi.org/10.1007/s11886-018-1043-2

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